Budget Office Lowers Its Forecast for Obamacare Enrollment

When the Affordable Care Act was drafted, the Congressional Budget Office expected people to sign up quickly for new health insurance.

Now, two years into the law, it’s clear that progress is going to be slower. The Obama administration acknowledged as much in late 2014, and again in October, when it presented its own modest predictions. Monday, the budget office also agreed, slashing its 2016 estimate by close to 40 percent.

The Obamacare marketplaces have helped millions of Americans get health insurance, but they have not caused the kind of immediate and drastic plunge in the ranks of the uninsured that analysts had hoped for before the law was passed. It has proved harder to spread the word about new health insurance, and harder yet to persuade people to shell out money for new health insurance they hadn’t had in their household budgets.

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The scene at a recreation center in San Francisco during open enrollment for the Affordable Care Act in November 2015.CreditJim Wilson/The New York Times

The new budget and economic outlook now predicts that about 13 million people will get their health insurance through the Obamacare marketplaces this year, down from an earlier estimate of 21 million. The budget office’s estimates for future years won’t be released until March, but it seems reasonable to assume they will also come down. Currently, the 2017 estimate is 24 million.

The revisions to early estimates show how it’s possible to say both that the Affordable Care Act has created a “path to universal coverage” — as Hillary Clinton did at the last Democratic presidential debate — and that it has left nearly 29 million uninsured, as Bernie Sanders responded.

The slower growth of enrollment in the new marketplace plans is not a sign that the health law is failing. Another part of the report shows that sign-ups for Medicaid, expanded in many states because of the health law, have been extraordinarily popular. Sign-ups last year were 20 percent higher than the budget office had expected. And enrollment in employer health plans has basically held steady, despite expectations that employers might drop coverage once their workers had other ways to get insurance. Surveys show that the number of Americans without health insurance is lower than ever before.